Related Experiment Video
Updated: Jul 24, 2025
06:14
Translational Rabbit Model of Chronic Cardiac Pacing
Published on: January 6, 2023
2.6K
Case report: Migrating temporary epicardial pacing wire eroding into an ascending aortic aneurysm
Aaron E Tipton1, Adam Daly1, Faisal G Bakaeen1
1Cleveland Clinic, Department of Thoracic and Cardiovascular Surgery, Cleveland, OH, United States of America.
International Journal of Surgery Case Reports
|July 10, 2023
Summary
Temporary epicardial pacing wires (TEPW) migrating into an ascending aortic aneurysm is a rare complication. This case highlights successful operative management and TEPW removal during re-operative cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Medical Device Complications
- Aortic Surgery
Background:
- Temporary epicardial pacing wires (TEPW) are frequently used after cardiac surgery.
- TEPW migration is a known complication, with previous reports of migration into the ascending aorta.
- Conservative management with antithrombotics and surveillance has been typical for TEPW migration.
Observation:
- A 73-year-old male presented for re-operative cardiac surgery due to severe aortic stenosis, ascending aortic aneurysm, and coronary artery disease.
- Pre-operative imaging revealed incidental TEPW migration into the ascending aorta.
- The patient had a history of aortic valve replacement and coronary artery bypass grafting.
Findings:
- This is the first reported case of TEPW migration into an ascending aortic aneurysm.
- The TEPW was successfully removed during re-operative surgery, including aortic valve replacement, ascending aorta replacement, and coronary artery bypass grafting.
- The patient experienced a well recovery and was discharged home.
Implications:
- TEPW migration into an aneurysmal aorta necessitates careful consideration of surgical intervention versus conservative management.
- Operative management can be successful in cases of TEPW migration into an ascending aortic aneurysm.
- This case underscores the importance of pre-operative imaging for detecting TEPW migration, especially in patients with pre-existing aortic pathology.
Related Concept Videos
01:26Aneurysm III: Interprofessional Care
10
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
10
01:22Aneurysm IV: Nursing Management
8
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
8
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
10
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
10
01:30Aneurysm I: Introduction
15
An aortic aneurysm is a localized outpouching or dilation at a weak point in the artery wall. It may involve different parts of the aorta, such as the abdominal aorta, aortic arch, or thoracic aorta.Etiological factorsSeveral disorders are associated with aortic aneurysms.Congenital causes, such as primary connective tissue disorders like Marfan syndrome, impact the integrity and strength of connective tissues, notably affecting the aorta. Marfan syndrome is a genetic disorder that specifically...
15
01:15Aortic Regurgitation I: Introduction
18
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
18
01:25Aortic Regurgitation III: Medical Management
26
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
26